Flashcards in GI UWorld: Path and Pharm Deck (82)
Crohn's disease: gross appearance and histology
Linear ulcers and normal mucosa interspersed --> cobblestone appearance. Creeping fat.Histo: non-caseating granulomas, lymphoid inflammatory infiltrate (Th1 mediated)
What cell type mediates Crohn's disease?
Describe squamous cell carcinoma histology. What is the importance of keratin?
Nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct bordersKeratinization means that the tumor is poorly differentiated --> poor prognosis.
What 3 organisms are most common causes of esophagitis? What patients is this found in?
Found in immunocompromised. Candida albicans, HSV-1, and CMV.
Gross and histologic features: Candida esophagitis
Gross: white pseudomembranesHisto: yeast cells and pseudohyphae that invade mucosal cells
Gross and histologic features: HSV esophagitis
Gross: "punched out" ulcersHisto: eosinophilic intranuclear inclusions in multinuclear squamous cells at margins of ulcers.
Gross and histologic features: CMV esophagitis
Gross: linear ulcerations
Histo: intranuclear and cytoplasmic inclusions
Where is H. pylori found in greatest concentration in the GI tract?
Prepyloric area of the gastric antrum (even if it is a duodenal ulcer)
Presentation of carcinoid syndrome
Dyspnea, wheezing, cutaneous flushing, diarrhea. Maybe right sided valvular disease
Tx of carcinoid syndrome
Resection and somatostatin analogue, aka octreotide (inhibits secretion of many hormones)
Where should you biopsy for Hirshprung's?
Must go down to the submucosa to see the lack of ganglion cells - mucosa alone is not enough.
Also this is for the constricted portion, not dilated.
Presents in early childhood. Failure to thrive, steatorrhea, malabsorption, acanthocytosis, ataxia, night blindness.
Abetalipoproteinemia: labs and biopsy
Low plasma triglycerides, low cholesterol, no chylomicrons, VLDLs, apoBs. Poor absorption of ADEK.
Classification of adenomatous polyps
Tubular: smaller, pedunculated, dysplastic mucosal cells form tubular-shaped glands.
Villous: larger, sessile, dysplastic epithelial cells form villi-like projections. Velvety or cauliflower like masses. Increased risk of adenocarcinoma.
Difference between erosions and ulcers
Erosions do not fully extend through the muscularis mucosa (but they can reach it)
Ulcers penetrate through the mucosa into submucosa.
What is the first event in the pathogenesis of acute appendicitis?
Histology of Crohn's disease
Non-caseating granulomas, lymphoid aggregates
Multiple hemorrhagic polypoidal lesions, spindle cells with surrounding blood vessel proliferation in the setting of untreated HIV. Dx?
Kaposi's sarcoma: colonoscopy findings, biopsy findings, other organ system involvement
Colonoscopy: red/violet, flat maculopapular lesions or hemorrhagic nodules
Biopsy: spindle-shaped tumor cells with small vessel proliferation.
Endothelial malignancy in skin, mouth, GI tract, respiratory tract, associated with HHV-8 and HIV
CMV colonoscopy and biopsy findings
Colonoscopy: multiple ulcers, mucosal erosions
Biopsy: cytomegalic cells with inclusion bodies
Cryptosporidium colonoscopy and biopsy findings
C: nonulcerative inflammation
B: Basophilic clusters on surface of intestinal mucosal cells
Characteristics of colitis-associated colorectal carcinoma
Affects younger patients, multifocal, progresses from flat non-polypoid lesions, mucinous or signet ring histology, early p53 and late APC mutations, disease is dependent on length of colitis (>10 years)
Congenital pyloric stenosis: "olive sized" mass is from:
smooth muscle hypertrophy
Systemic mastocytosis: cause and effects
Mast cell proliferation in marrow and organs.
Syncope, flushing, hypotension, tachycardia, bronchospasm, pruritis.
GI symptoms from increased gastric acid secretion: diarrhea (inactivated pancreatic enzymes), nausea, vomiting, cramps.
Which gastritis is associated with the antrum?
Type B - H. pylori
Differentiate between acute and chronic gastritis
Acute = neutrophil dominant
Chronic = lymphocyte and plasma cell predominant
Presentation of chronic gastritis
epigastric abdominal pain, occasional nausea, not related to food intake, inflammatory infiltrate
Presentation of Crohn's
Fever, right lower quadrant pain (terminal ileitis), diarrhea, involves GI tract not stomach!
Damage seen in pernicious anemia
Immune mediated destruction of gastric mucosa --> Chronic atrophic gastritis. Loss if IF-secreting cells (B12 deficiency, megaloblastic anemia), lymphocytic and plasma cell infiltration, megaloblastic changes